MAJOR NEUROCOGNITIVE DISORDER (DEMENTIA)

• Major neurocognitive disorder (previously called dementia) is an acquired disorder of cognitive function usually of chronic or progressive nature, in which there is impairment of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment
• Impairments of cognitive function are commonly accompanied or occasionally preceded by deterioration in emotional control, social behaviour, or motivation. Overall Prevalence is 5-10 % after 60 or 65 years old

• Parenchymatous brain disease- Alzheimer’s disease, Pick’s disease, Parkinson’s disease, Huntington Chorea
• Vascular causes – Multi-infarct, Subcortical vascular Dementia
• Toxic causes – Bromide Intoxication, Heavy Metals, Alcohol, Psychotropic Drugs
• Metabolic causes – Chronic Hepatic Or Uraemic Encephalopathy, Wilsons Disease
• Endocrine causes – Thyroid, Parathyroid, Pituitary, Adrenal Dysfunction
• Deficiency – Pernicious Anaemia, Pellagra, Folic Acid Deficiency, Thiamine Deficiency
• Infections – Chronic Meningitis, Neurosyphilis
• Neoplasm – Intracranial space-occupying lesions
• Traumatic - Head Injury, Chronic subdural haematoma

• The signs and symptoms linked to dementia can be understood in three stages.

Early-stage: The early stage of dementia is often overlooked because the onset is gradual. Common symptoms include:

• forgetfulness
• losing track of the time
• becoming lost in familiar places.

Middle stage: As dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include:

• becoming forgetful of recent events and people's names
• becoming lost at home
• having increasing difficulty with communication
• needing help with personal care
• Experiencing behaviour changes, including wandering and repeated questioning.

Late-stage: The late stage of dementia is one of near-total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:

• becoming unaware of the time and place
• having difficulty in recognizing relatives and friends
• having an increasing need for assisted self-care
• having difficulty in walking
• experiencing behavioural changes that may escalate and include aggression

Additional cognitive impairment

• Speech - Aphasia, word-finding difficulty

Differential diagnosis

• Alzheimer's disease – Slow, progressive, episodic impairment of memory
• Vascular dementia – abrupt cognitive decline
• Lewy body dementia – steady decline, visual hallucinations
• Fronto temporal dementia – early changes in personality, apathy
• Pseudo dementia- associated with major depression, mimics dementia, memory loss
• Normal ageing

• Clinical diagnosis as per the ICD11 or DSM 5 criteria.
• Mini-Mental Status Examination (MMSE), Montreal Cognitive Assessment and Modified Mini-Mental Status Examination are the common assessment tools used for screening and diagnosis.
• Dementia severity rating scale used to assess the severity of the condition.
• MRI Brain
• Investigations: CBC, urea and electrolytes, TFT, Vitamin B12 and folate.

Memory training

Internal Medicines:

• Brahmidrakshadi kashaya , Drakshadi Kashaya
• Sankhupushpi choorna + Aswagandha choorna in equal quantity (can be given in the form of ksheerapaka)
• Samana snehapana - Kooshmanda swarasa ghrita, Brahmikalyanaka ghrita, Brahmi ghrita, Saraswata ghrita
• Saraswata choorna
• Saraswatharishta , Aswagandharishta

Procedures:

• Snehapana followed by mridu Virechana
• Nasya with Ksheerabala taila/ Saraswata grhita/ Brahmi ghrita
• Siropichu, Siro taila dhara, Sirovasti - Dhanwantharam taila / Ksheerabala taila.
• Sankhupushpi vardhamana rasayana